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PRENATAL CARE IN CLINIC
Desert Rain Midwifery follows a standard prenatal visit schedule for healthy, low-risk women and birthing people, outlined below. Visits are about far more than taking your blood pressure and measuring your belly. We care for the whole person! Your prenatal visits will always cover important medical monitoring such as listening to baby, checking your blood pressure, and measuring fundal growth. In addition, at each visit we will really listen to how you’re doing, answer your questions, check-in on your stress levels and emotional health, discuss the joys and challenges of pregnancy, and help you begin preparing for birth as that time approaches. This is how relationship and trust are built between client and midwife. Visits range from 30 minutes to 1 hour.
Click here for information on required screening in pregnancy.
THE CHILDBEARING YEAR
Pregnancy, Labor, Birth, Dyad Care (Postpartum & Newborn Care)
Complete care for the childbearing year consists of the services outlined below. Additional visits, tests, and services may be indicated based on your individual situation. If this is your first baby or your first time giving birth without an epidural, click here for additional requirements.
Prenatal Care in Clinic
Desert Rain Midwifery follows a standard prenatal visit schedule for healthy, low-risk women and birthing people, outlined below. Visits are about far more than taking your blood pressure and measuring your belly. We care for the whole person! Your prenatal visits will always cover important medical monitoring such as listening to baby, checking your blood pressure, and measuring fundal growth. In addition, at each visit we will really listen to how you’re doing, answer your questions, check-in on your stress levels and emotional health, discuss the joys and challenges of pregnancy, and help you begin preparing for birth as that time approaches. This is how relationship and trust are built between client and midwife. Visits range from 30 minutes to 1 hour.
10-12 weeks | Initial visit, history taking, initial pregnancy labs, likely to be able to hear baby’s heartbeat in clinic, possibly order dating ultrasound
16 weeks | You are likely to have felt baby move by now
20 weeks | Anatomy scan
24 weeks | Review anatomy scan results
28 weeks | Glucose screen, 28 week pregnancy labs
30 weeks | Review glucose screen and 28 week lab results
32 weeks | Breast pump desired? Classes begun?
34 weeks | Discuss preparation for home visit
36 weeks | Home visit, group B strep (GBS) test
37 weeks | Congratulations! You are now in the green zone. Baby is welcome to be born at home any time they’re ready between now and 42 weeks and 0 days. Review GBS results.
38 weeks | Looking towards labor
39 weeks | May start membrane sweeps if desired.
40 weeks | This is officially your due date. Only about 4% of babies are born on their due date. ☺
Repeat GBS test.
41 weeks | If still pregnant, a non-stress test and biophysical profile are required.
41 weeks 3 Days | If still pregnant, a non-stress test is required.
41 weeks 6 Days | If still pregnant, a non-stress test is required.
42 weeks 0 Days | If still pregnant and not in active labor, then transfer to hospital will be facilitated.
CLICK HERE for information on required screening in pregnancy.
Labor, Birth, and Immediate Postpartum Care at Home
Your baby can be born at home with Desert Rain Midwifery between 37 weeks and 0 days and 42 weeks and 0 days of pregnancy. Your midwife is available 24/7 via phone and, in conversation with you, she usually arrives to your home once active labor is established (though timing of arrival can vary based on each situation). In addition to labor support, the midwife and birth assistant provide full medical care in your own home. They bring all medical supplies that may be needed including IV supplies, pain medication, anti-hemorrhage medication, resuscitation equipment, and much more. (For a list of non-medical items the client provides click here.)
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Labor support (reassuring presence, suggestions for positioning and pain coping, explanation of what’s happening, techniques for maintaining strength, etc.)
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Intermittent electronic fetal monitoring
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Monitoring of birthing person’s vitals
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IV hydration and/or medication as needed
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Land or water birth (if water birth is desired, client provides tub)
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Treatment of excess bleeding in the birthing person
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Assistance in helping baby transition upon birth including neonatal resuscitation if indicated
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Assistance with establishing breastfeeding if desired
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Repair of 1st and 2nd degree tears
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Newborn exam
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Administration of vitamin K and erythromycin eye ointment for baby if desired
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Glucose monitoring for baby if indicated
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Monitoring of newborn and mother/birthing person for 2-4 hours after birth to ensure stabilization
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Clean-up
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Transfer to a higher level of care (hospital) should indications arise at any point
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Dyad Care (Postpartum & Newborn Care)
Dyad means something that consists of two parts. In the first few weeks of life, a mother/birth parent and the newborn are a dyad – they are separate people but so deeply woven together as to form a single unit. Indeed, newborns don’t know they’re separate from their parent; they rely completely on their caregiver to regulate basic functions such as heartbeat, breathing, temperature, and stress levels. In the words of British pediatrician D. W. Winnicott, “There is no such thing as a baby, there is a baby and someone.” The early weeks are for deepening this connection as much as possible. Thus, most postpartum and newborn care occurs together at the same visit by the same provider to care for the dyad.
Dyad: Postpartum Care for Mother/Birth Parent in Home and Clinic
Postpartum care focuses on recovery after childbirth and transition to parenthood. Routine visits include careful monitoring of bleeding, uterine size, and watching for signs of infection or postpartum complications. The midwife will assist you to establish and maintain breastfeeding, bottle-feeding, or formula feeding based on your preferences. She will assess bonding, provide support for prioritizing sleep and nutrition, and help you navigate emotional changes and family transitions. The 1-day visit (24-36 hours after birth) occurs at home. All other visits occur in clinic.
1 day (24-36 hours) Home visit. Bleeding has slowed, cramping likely present, soreness from birth, colostrum present
3 day | Decrease in cramping, increase in fatigue, milk often in and possible engorgement, first bowel movement passed
2 weeks | Feeling more mobile, breastfeeding usually established
4 weeks | Finding a rhythm
6-8 weeks | This visit includes a Pap if indicated and birth control prescription or placement if desired. Breastfeeding-friendly birth control options (progesterone only pills, IUD, Nexplanon, Caya) are offered at Desert Rain Midwifery.
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Dyad: Newborn Care in Home and Clinic
CNMs are trained and certified to care for newborns for the first 6 weeks of life. Routine visits are centered around newborn’s health and growth, feeding, pees, poops, bonding, and milestones. As long as your newborn is healthy and well, Desert Rain Midwifery can provide all the care your newborn needs for the first 6 weeks of life. After their 6 week visit, newborns transfer to their pediatric provider of choice (pediatrician, family practice doc, or pediatric nurse practitioner). Should your newborn require a higher level of care in the first 6 weeks, we will facilitate this transfer sooner.
1 day (24-36 hours) Cardiac screen (CCHD), 1st metabolic screen, bilirubin screen
3 day | Bilirubin screen, often peak weight loss and feeding support
2 weeks | 2nd metabolic screen, hearing test
4-6 weeks | Milestones and growth
What is not provided by Desert Rain Midwifery, but necessary to your medical care?
Lab costs – Cost is determined by the lab where your samples are sent; Desert Rain has no control over this cost. Required pregnancy labs are usually covered by insurance. Costs of optional pregnancy labs (such as genetic testing) will be reviewed with you by the perinatologist prior to you determining if you would like these optional tests.
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Ultrasounds – Determined by the perinatologist; insurance usually covers a portion.
Additional services that may be necessary to your care include:
First Unmedicated Birth Requirements
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When a Health Challenge Arises
A health challenge during the childbearing year may necessitate extra visits in order to give the issue the attention it deserves. Extra visits may include a Basic Mental Health visit for anxiety/depression, a Problem visit to address a wide range of concerns, Lactation Care, a Newborn Weight Check , or a Newborn Bilirubin Check . Costs for these visits are outside of the Desert Rain Midwifery childbearing year fee.
Pregnancy Loss
Should you face pregnancy loss, Desert Rain Midwifery will provide you with sensitive, expert, timely medical care delivered with the warmth of a midwife. Click here to learn more about what this looks like.
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